Page 1 of 6
Permit No.:
PARK USE REQUEST FORM
Honesdale Borough
Parks & Recreation
958 Main Street, PA 18431
Phone (570) 253-0731 | Email: info@honesdaleborough.com
Honesdale Borough Parks are open to the public on a first-come, first-served basis, and can be used in standard ways by individuals and small groups during park hours freely. You can also reserve areas ahead of time or hold special events with an approved request.
To make a request, please read and fill out this form and email or mail it and any other necessary documents to the address above.
Information About Your Event
Organization Name:
Contact Name:
Date:
-
Month
-
Day
Year
Date
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone No.:
Format: (000) 000-0000.
Email Address:
example@example.com
Title of Event:
Please describe your event:
Date of Event:
-
Month
-
Day
Year
Date
Rain Date:
-
Month
-
Day
Year
Date
N/A
Time Requested: from
Hour Minutes
AM
PM
AM/PM Option
to
Hour Minutes
AM
PM
AM/PM Option
Estimated Attendees
Location:
If you need more room to describe your event's location, attach a map or additional information.
If a hauler will be hired for your event, please provide details regarding date of pickup below:
Trash Removal Plan:
will remove all trash generated from this event by
-
Month
-
Day
Year
Date
Version 24.03
Back
Next
Page 2 of 6
Permit No.:
Event Details
Reminder: Alcohol is prohibited from all Borough Properties
A. Is this a public event?
*
Yes
No
B. Is your event a protest or rally¹
*
Yes
No
C. Will you be filming/doing a photo shoot?²
*
Yes
No
D. Will electricity be needed?³
*
Yes
No
Please specify location
E. Will you be using loudspeakers?
*
Yes
No
F. Will any structure/tents be erected? ⁴
*
Yes
No
Please specify location(s):
G. Do you expect to have 75+ attendees? ⁵
*
Yes
No
H. Will food/refreshments be sold? ⁶
*
Yes
No
Please specify location(s):
I. Will there be non-food vendors? ⁶
*
Yes
No
Please specify location(s):
J. Will porta potties be brought in?
*
Yes
No
Please specify location(s):
K. Will the event last longer than 6 hours?
*
Yes
No
L. Will you be reserving parking spaces?⁷ §195-19 (Metered Parking Times)
*
Yes
No
Please specify location(s):
M. Will there be a request for closing any streets and or sidewalks??
*
Yes
No
If so, a Road Closure Form will be required.
Please specify street(s):
N. Will adjacent streets/sidewalks be impacted? ⁷
*
Yes If
No
yes please explain where, and for how long.
O. Is this a recurring event (e.g., soccer practice)?
*
Yes
No
P. Will any part of it occur between 9:00 PM and 5:00 AM? ⁷
*
Yes
No
Please explain
Back
Next
Page 3 of 6
Q. Will a stage be brought in/used?
*
Yes
No
R. Will the Honesdale Pool be used?
*
Yes
No
S. Will there be fireworks?
*
Yes
No
1 If a protest or rally is planned, approval is not required under the First Amendment. However, please call the Borough Office to notify them ASAP so that public safety and traffic control measures can be evaluated. 2 Requests for this use only need to be submitted if you are filming/photographing in one area for more than five minutes AND normal public activities like walking or talking nearby would need to be prevented. Photography/videography that does not create an exclusive park use situation is always allowed. 3 If yes, please include a $20 check for the first day and $10.00 for each day thereafter, payable to Honesdale Borough and explain any relevant details. 4 Tents must be secured. Sandbags are preferred. If using stakes, call PA One Call ahead of your event (telephone #811). 5 An event with 75 or more estimated attendees requires an Emergency Action Plan to be submitted to the borough once your event is approved. For details, call Stan Pratt, Borough EMA Coordinator, T: (570) 470-0905. 6 Sales of any kind are not allowed in Central Park, but are permitted on the streets nearby, if closed off to driving. If road closing is necessary for this reason, answer "yes" to question "N." 7 If yes, please explain where and for how long. (Metered Parking Times) $195-19. 8 If yes, please complete the "Request to hold a Parade/Road Closure Form" and include it with your request. 9 Use of the Central Park stage requires a deposit of $250.00. 10 If yes, please call the Borough Pool at (570) 616-5441 to discuss ahead of time to assess an appropriate fee and lifeguarding needs. Attach any relevant information based on that conversation to this form. 11 Fireworks may only occur on Irving Cliff in Gibbons Park and require a "Fireworks Permit" form. Fireworks $110
General Rules and Requirements
The Basics:
Reservations are not guaranteed.
Honesdale Borough staff reserves the sole right to cancel any event or use or to reassign any area(s) as needed.
Honesdale Borough reserves the right to revoke the granted parks request in the event of a public health emergency, such as air quality or at or above an orange alert level or public safety emergencies.
Back
Next
Page 4 of 6
If standby EMS personnel, police assistance, traffic control, or additional services are determined to be required - in the borough's sole discretion - the applicant will be notified of the requirement and must contact the appropriate departments and/or other service providers to arrange for such services for their event to be approved.
Exclusive use is limited to the designated area and does not extend to restrooms, playground equipment, pools, and parking areas. All restrooms or other amenities will be available only as weather and/or maintenance permits.
Cancellations:
If necessary to cancel an approved event, notify the Honesdale Borough Office as soon as possible, or at least 6 hours before the start of the event.
Electricity deposits can be applied to a rescheduled event, but once an event is scheduled, will not be refunded.
During Your Event:
The person signing this form (or designee) must be present at the event and must have this approved request on site.
For private events, the person signing this form assumes personal liability for breakage, destruction, or removal of borough property by any persons attending the event and is responsible for the conduct of attendees. For public events, the person signing this form is only responsible in the ways mentioned above for those involved in putting on the event (volunteers, representatives, organizers). If destruction or dangerous actions occur during your public event, call the appropriate emergency services.
Follow all Honesdale Parks & Recreation Rules.
Use structures, objects, and areas as they are intended to be used.
Alcohol is prohibited in all parks and on Borough Property.
Unless a separate request is made, use of space for an event applies only to the park space specified itself- nearby sidewalks, parking spaces, streets, and other areas must be kept free for regular public use.
Parking shall be in legal, approved areas only.
At the Conclusion of Your Event:
All of your equipment and supplies must be removed from park premises..
Take trash generated from your event with you - do not leave it in park trash cans.
Designate a person or people to do a "final sweep" of the park to ensure it is free of litter, following Honesdale Borough's "Leave No Trace Behind" ethic.
An approved request may be immediately revoked if the applicant or their guests fail to abide by Park rules or event requirements, or if the stated use has been misrepresented.
Insurance Information and Requirements
The Borough requires a Certificate of Insurance that meets the criteria below once your request is approved. Certificates listing the Borough as "additional insured" must be received 2 days prior to the event.
Individuals:
The applicant must submit a copy of their homeowner's or renter's insurance policy showing a minimum of $300,000 liability coverage.
Organizations (businesses, non-profits, leagues, groups, or similar):
The applicant must provide a certificate of insurance indicating comprehensive general liability coverage of not less than $1,000,000 each occurrence naming the "Honesdale Borough, 958 Main Street, Honesdale, PA 18431" as a Certificate Holder and an Additional Insured.
Back
Next
Page 5 of 6
Response Time Guidelines
Basic Events can typically be reviewed by the Borough Office within 3-5 days.
All Events will be reviewed by the Honesdale Parks & Recreation Committee and/or Commission at its monthly meeting and forwarded to the Honesdale Borough Council for final approval.
You may be asked to attend to answer any questions that may come up.
Park Use Agreement
By signing below, I certify that:
A. I am at least 18 years of age.
B. I have read and fully understand ALL OF THE REQUIREMENTS and information about the use of Honesdale Borough Park facilities.
C. I agree on behalf of myself and any other entity named above, to assume all risks and responsibility in connection with the use of the parks facilities requested above and hereby release, absolve, indemnify, and hold harmless the Borough of Honesdale and its employees from any and all claims and all cost, damage, legal fees, and any other expenses reasonably incurred which arise out of authorization to use a Honesdale Park Facility.
E. I agree on behalf of myself, and any entity named above, to abide by all State and Federal laws, the Honesdale Borough Park rules and regulations, and any other rules or conditions that may be applied to the request pertaining to the use of Honesdale Borough parks.
F. I understand that failure to abide by any of the provisions of this document and/or any applicable law is grounds for immediate revocation of this agreement and cancellation of the event.
G. To Acknowledge the complete contents of this form, I have initialed each page, thereby verifying comprehension and compliance of the same.
H. I have attached the following applicable forms:
(a) $20.00 Electricity Use Fee:
(b) Emergency Action Plan:
(c) Additional Insured Certificate:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature:
Date:
-
Month
-
Day
Year
Date
Printed Name:
Remember to attach any necessary forms, additional information, or fees, if applicable.
Back
Next
Page 6 of 6
Permit No.:
REQUEST STATUS * FOR BOROUGH USE ONLY
I. To be completed by Borough Office:
Approved by Borough Office
Denied by Borough Office
Changes or Stipulations Required for Approval:
Date:
-
Month
-
Day
Year
Date
By:
II. To be completed by Parks and Rec Committee/Commission Member:
Recommended for Approval by Parks & Rec Commission
Denied by Parks & Rec Commission
Changes or Stipulations Required for Approval:
By:
Date:
-
Month
-
Day
Year
Date
III. Final Approval to be completed by Borough Council:
Approved by Borough Office
Denied by Borough Council
Changes or Stipulations Required for Approval:
By:
Date:
-
Month
-
Day
Year
Date
Applicant Notified of Formal Review results on:
-
Month
-
Day
Year
Date
Letter
Email
Date Added to Borough Calendar:
-
Month
-
Day
Year
Date
Version
24.03
Preview PDF
Submit
Should be Empty: